Download:
pdf |
pdfCaution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
release date on our web site (www.irs.gov).
If you have any comments on this draft form, you can
submit them to us on our web site. Include the word
DRAFT in your response. You may make comments
anonymously, or you may include your name and
e-mail address or phone number. We will be unable
to respond to all comments due to the high volume
we receive. However, we will carefully consider
each suggestion. So that we can properly consider
your comments, please send them to us within 30
days from the date the draft was posted.
Form
4136
f
o
s
a
7
t
0
f
0
a
2
r
/
D /15
8
0
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0162
Credit for Federal Tax Paid on Fuels
2007
See the separate instructions.
Attachment
Sequence No.
Attach this form to your income tax return.
Name (as shown on your income tax return)
23
Taxpayer identification number
Caution. Claimant has the name and address of the person who sold the fuel to the claimant and the dates of purchase.
For claims on lines 1c and 2b (type of use 13 and 14), 3d, 4c, and 5, claimant has not waived the right to make
the claim. For claims on lines 1c and 2b (type of use 13 and 14), claimant certifies that a certificate has not
been provided to the credit card issuer.
1
Nontaxable Use of Gasoline
(a) Type of use
a
b
c
d
2
Off-highway business use
(b) Rate
(c) Gallons
$ .183
Use on a farm for farming purposes
.183
Other nontaxable use (see Caution above line 1)
.183
Exported
.184
(d) Amount of credit (e) CRN
$
362
411
Nontaxable Use of Aviation Gasoline
(a) Type of use
a Use in commercial aviation (other than foreign trade)
Caution. This credit is not available for aviation
gasoline taxed at $.044 (purchased after
September 30, 2007).
b Other nontaxable use (see Caution above line 1)
c Exported
(b) Rate
(c) Gallons
(d) Amount of credit (e) CRN
$
354
$ .15/.000*
.193/.043*
324
.194/.044*
412
*This rate applies after September 30, 2007.
3
Nontaxable Use of Undyed Diesel Fuel
Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach an explanation and check here
(a) Type of use (b) Rate
(c) Gallons
(d) Amount of credit (e) CRN
a Nontaxable use
$
$ .243
360
.243
b Use on a farm for farming purposes
.243
c Use in trains
353
d Use in certain intercity and local buses (see Caution
above line 1)
Exported
e
4
.17
350
.244
413
Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation)
Claimant certifies that the kerosene did not contain visible evidence of dye.
Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation and check here
(a) Type of use (b) Rate
(c) Gallons
(d) Amount of credit (e) CRN
a Nontaxable use
b Use on a farm for farming purposes
$ .243
.243
$
346
c Use in certain intercity and local buses (see Caution
above line 1)
d Exported
e Nontaxable use taxed at $.044
f Nontaxable use taxed at $.219
For Paperwork Reduction Act Notice, see the separate instructions.
.17
347
.244
414
.043
377
.218
369
Cat. No. 12625R
Form
4136
(2007)
Form 4136 (2007)
Page
2
Kerosene Used in Aviation (see Caution above line 1)
5
f
o
s
a
7
t
0
f
0
a
2
r
/
D /15
8
0
(a) Type
of use
(b) Rate
(c) Gallons
(d) Amount of credit (e) CRN
a Kerosene used in commercial aviation (other than foreign
trade) taxed at $.244
$ .200
$
417
b Kerosene used in commercial aviation (other than foreign
trade) taxed at $.219/.044*
.175/.000*
355
Caution. This credit is not available for kerosene
taxed at $.044 (purchased after September 30, 2007).
c Nontaxable use (other than use by state or local
government) taxed at $.244
.243
346
d Nontaxable use (other than use by state or local
government) taxed at $.219/.044*
.218/.043*
369
*This rate applies after September 30, 2007.
6
Sales by Registered Ultimate Vendors of Undyed Diesel Fuel
Registration No.
Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written
consent of the buyer to make the claim. Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach an explanation and check here
(b) Rate
a Use by a state or local government
b Use in certain intercity and local buses
7
Sales by Registered Ultimate Vendors of Undyed Kerosene (Other
Than Kerosene For Use in Aviation)
(c) Gallons
$ .243
360
350
$
.17
Registration No.
(d) Amount of credit (e) CRN
Claimant certifies that it sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent
of the buyer to make the claim. Claimant certifies that the kerosene did not contain visible evidence of dye.
Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation and check here
(b) Rate
(c) Gallons
(d) Amount of credit (e) CRN
a Use by a state or local government
$ .243
346
$
b Sales from a blocked pump
.243
c Use in certain intercity and local buses
8
Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation
.17
Registration No.
347
Claimant sold the kerosene for use in aviation at a tax-excluded price and has not collected the amount of tax from the buyer, repaid
the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. See the instructions for additional
information to be submitted.
(a) Type of use (b) Rate
(c) Gallons
(d) Amount of credit (e) CRN
a Use in commercial aviation (other than foreign trade)
taxed at $.219/.044*
$
355
$ .175/.000*
Caution. This credit is not available for kerosene
taxed at $.044 (purchased after September 30,
2007).
b Use in commercial aviation (other than foreign trade)
taxed at $.244
c Nonexempt use in noncommercial aviation
d Other nontaxable uses taxed at $.244
e Other nontaxable uses taxed at $.219/.044*
417
.200
.025/.200*
418
346
.243
.218/.043*
369
*This rate applies after September 30, 2007.
Form
4136
(2007)
Form 4136 (2007)
9
Alcohol Fuel Mixture Credit
Page
3
Registration No.
f
o
s
a
7
t
0
f
0
a
2
r
/
D /15
8
0
Claimant produced an alcohol fuel mixture by mixing taxable fuel with alcohol. The alcohol fuel mixture was sold by the claimant to any
person for use as a fuel or was used as a fuel by the claimant.
(b) Rate
a Alcohol fuel mixtures containing ethanol
b Alcohol fuel mixtures containing alcohol (other than ethanol)
10
(c) Gallons of
alcohol
(d) Amount of credit (e) CRN
$
$ .51
.60
Biodiesel or Renewable Diesel Mixture Credit
393
394
Registration No.
Claimant produced a mixture by mixing diesel fuel with biodiesel or renewable diesel. The biodiesel used to produce the biodiesel mixture
must meet ASTM D6751 and be registered with the EPA as a fuel and fuel additive under section 211 of the Clean Air Act. The mixture was
sold by the claimant to any person for use as fuel or was used as a fuel by the claimant. Claimant has a certificate from the producer or
importer of the biodiesel which identifies the percentage of biodiesel and agri-biodiesel in the product, and has no reason to believe the
information is false. See the instructions for line 10 to see if you must attach the certificate.
(b) Rate
a Biodiesel (other than agri-biodiesel) mixtures
b Agri-biodiesel mixtures
c Renewable diesel mixtures
11
(c) Gallons of
biodiesel or
renewable
diesel
(d) Amount of credit (e) CRN
$
$ .50
388
390
1.00
1.00
307
Nontaxable Use of Alternative Fuel
Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See page 4 in the Instructions for Form 4136 for the credit rate.
(c) Gallons
(a) Type of use
(b) Rate
(d) Amount of credit (e) CRN
or gasoline
gallon
equivalents (GGE)
$
a Liquefied petroleum gas (LPG)
$ .183
419
.183
420
b “P Series” fuels
c Compressed natural gas (CNG) (GGE = 126.67 cu. ft.)
d Liquefied hydrogen
e Any liquid fuel derived from coal (including peat) through
the Fischer-Tropsch process
f Liquid hydrocarbons derived from biomass
g Liquefied natural gas (LNG)
12
.183
.183
421
422
.243
.243
.243
423
424
425
Alternative Fuel Credit and Alternative Fuel Mixture Credit
Registration No.
(b) Rate
a
b
c
d
e
Liquefied petroleum gas (LPG)
$ .50
“P Series” fuels
Compressed natural gas (CNG) (GGE = 121 cu. ft.)
.50
Liquefied hydrogen
Any liquid fuel derived from coal (including peat) through the
Fischer-Tropsch process
.50
f Liquid hydrocarbons derived from biomass
g Liquefied natural gas (LNG)
(c) Gallons
or gasoline
gallon
equivalents (GGE)
(d) Amount of credit (e) CRN
$
426
427
428
429
.50
.50
430
431
.50
432
.50
Form
4136
(2007)
Form 4136 (2007)
13
Registered Credit Card Issuers
Page
Registration No.
f
o
s
a
7
t
0
f
0
a
2
r
/
D /15
8
0
a Diesel fuel sold for the exclusive use of a state or local government
b Kerosene sold for the exclusive use of a state or local government
(b) Rate
$ .243
(c) Gallons
.243
4
(d) Amount of credit (e) CRN
$
360
346
c Kerosene for use in aviation sold for the exclusive use of a state or local
government taxed at $.219/.044*.
.218/.043*
369
*This rate applies after September 30, 2007.
14
Nontaxable Use of a Diesel-Water Fuel Emulsion
Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See page 4 in the Instructions for Form 4136 for the credit rate.
(a) Type of use
a Nontaxable use
b Exported
15
(b) Rate
.198
(b) Rate
16
(c) Gallons
(d) Amount of credit (e) CRN
$
310
(c) Gallons
(d) Amount of credit (e) CRN
$ .046
Exported Dyed Fuels
(b) Rate
a Exported dyed diesel fuel
b Exported dyed kerosene
17
(d) Amount of credit (e) CRN
$
309
306
Registration No.
Diesel-Water Fuel Emulsion Blending
Blender credit
(c) Gallons
$ .197
$ .001
415
416
$
.001
Total income tax credit claimed. Add lines 1 through 16, column (d). Enter here and on
Form 1040, line 70 (also check box b on line 70); Form 1120, line 32f(2); Form 1120S, line
23c; Form 1041, line 24g; or the proper line of other returns.
17 $
Form
4136
(2007)
File Type | application/pdf |
File Title | 2007 Form 4136 |
Subject | Credit for Federal Tax Paid on Fuels |
Author | SE:W:CAR:MP |
File Modified | 2007-08-15 |
File Created | 2007-06-14 |